Chapter 10: Leaving MD Anderson

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Chapter 10: Leaving MD Anderson

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In this chapter, Ms. Alt talks about coming to the understanding in the mid-nineties that her position in the institution had shifted and it was time to leave. She notes that she was the first female division head at MD Anderson. She explains that the emphasis of the institution had shifted, with new financial administrators coming in and reorganizing finances to exert an influence on how patient care was practiced. She notes that Dr. Charles LeMaistre was able to support her with an advantageous severance package. Next, Ms. Alt lists the areas in which she feels she left a lasting mark on the institutio in strengthening the role of the clinical nurse and promoting the idea that self-governance is not a privilege but a responsibility of all. She notes that she is being interviewed for a film produced by the Texas Nursing Association, then talks about how she began to settle into retirement after her departure from MD Anderson in 1995/96.

Identifier

Alt,J_02_20180618_S10

Publication Date

6-18-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subjects Story - Professional Path Leadership; On Leadership; Building/Transforming the Institution; Leadership; On Leadership; MD Anderson Culture; Working Environment; Growth and/or Change; Obstacles, Challenges; Critical Perspectives

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Chapter 10 Leaving MD AndersonA: Professional Path;CodesC: Leadership; D: On Leadership;B: Building/Transforming the Institution;C: Leadership; D: On Leadership;B: MD Anderson Culture;B: Working Environment;B: Growth and/or Change;B: Obstacles, Challenges;A: Critical Perspectives;

Tacey A. Rosolowski, Ph.D:

Interesting. So, I mean I kind of had it on my list to ask you about first of all the high points, you know when there were big changes in nursing. It sounds like we’ve covered a number. Are there some other kind of moments that were key, over the time that you were there?J

Joyce Alt, RN, MS:

I don’t know, just seeing it grow was important to me. The thing that I hated was the jealousy, and that sounds stupid, but I knew that it was a problem for some folks. [Yes, our nurses were being rewarded for the good job they were doing.] [ ]

Tacey A. Rosolowski, Ph.D:

How did that jealousy express itself?J

Joyce Alt, RN, MS:

Oh, “that’s just nursing,” I [would] hear that so much. Well, didn’t you expect them to get it, you know? And then, what put the frosting on the cake, every JCAHO review we had, nursing never got cited one time. That’s unbelievable.

Tacey A. Rosolowski, Ph.D:

Why do you think that was?J

Joyce Alt, RN, MS:

We were good at what we were doing and I’ll tell you though, it’s not just that. It takes a very strong management team to keep identifying the critical points that we should be watching. They kept up with the standards of care, made sure our staff were meeting them. It was wonderful.

Tacey A. Rosolowski, Ph.D:

I’m trying to get more of a sense, if you can, about this jealousy issue, you know not to kind of revisit something painful, but because it sounds like you guys were doing something really right, you were doing things right. Did people feel that there were other services within the organization that kind of hadn’t gotten themselves together to address workflow and their own internal challenges? Could you look at another service and say, ‘Oh, you know, maybe they should do that or they should do that?’ Because you guys had really identified what were the pressure points that you needed to work on. Do you know what I’m saying at all?J

Joyce Alt, RN, MS:

[Redacted] [Our division was respected and complimented, maybe too much as I was perceived as having too much power.]

Tacey A. Rosolowski, Ph.D:

And this was how you ended up leaving the division?J

Joyce Alt, RN, MS:

[I think that was a major part of it.]

Tacey A. Rosolowski, Ph.D:

And this was in 1995 or ’96?J

Joyce Alt, RN, MS:

Yeah it was, yeah.

Tacey A. Rosolowski, Ph.D:

Well, do you want to tell me about that scenario?J

Joyce Alt, RN, MS:

I felt something was coming. I was invited less and less, to participate in problem solving [with the administrative staff]. No recognition at all, of me, or more important, the staff. I got an awful, awful review, I couldn’t believe it. I thought something is happening here.

Tacey A. Rosolowski, Ph.D:

What were some of the things that jumped out at you from that review?J

Joyce Alt, RN, MS:

[I was told I could not] work with people, [ specifically the other] clinical heads. See, I was the first female division head [at MD Anderson] [ ] [and had gotten good reviews prior to that time][.

Tacey A. Rosolowski, Ph.D:

Do you think that being female and being in that position of power had—do you think being female was a factor there?J

Joyce Alt, RN, MS:

No, because one of my worst critics was female. [It seemed there was nothing I could do that was right; she would even make a point of critiquing me in group meetings] [ ] I went over to Human Resources and I said, “[ ] [I think I’m on my way out.] All I want to know is if you think so.” She said, “Joyce, move on,” she says, “because it isn’t going to get any better.” They were firing people right and left and she says, “I [ ] [will discuss with this Dr. LeMaistre].”

Tacey A. Rosolowski, Ph.D:

Now was this during the period where there was a lot of downsizing in the institution?J

Joyce Alt, RN, MS:

Yeah. Well, and after. We had a whole new management team and it was, what was happening to me was not unlike what was happening to my counterparts in the medical community.

Tacey A. Rosolowski, Ph.D:

Okay.J

Joyce Alt, RN, MS:

I think they were trying to get rid of any kind of nursing leadership.

Tacey A. Rosolowski, Ph.D:

Do you have any idea why that was the case?J

Joyce Alt, RN, MS:

Wanted more control, that was my feeling.

Tacey A. Rosolowski, Ph.D:

Interesting.J

Joyce Alt, RN, MS:

Anyway, she said, ‘I’m calling you back today.’ She said, ‘I’ve talked to Dr. LeMaistre, and he says just remind them that if it weren’t for me, there would be many a nights without patients getting care, give her anything she wants.’ She came back and she said, “What do you want?” I said, “I want what any other division head got as my severance and that’s it.” Which she did, but it was terrible, it was just terrible, and I had to leave because it was just tearing me up.

Tacey A. Rosolowski, Ph.D:

Well it’s very hard when you’ve given so much of yourself to an institution and you have made an impact, to feel like it goes down in flames at the end.J

Joyce Alt, RN, MS:

Well, and the people I could depend on were no longer there. Mr. Gilley had moved on, Dr. Hickey had moved on. Actually a lot of people had been terminated, but before I left, I went to the clinical head division heads and I said, “If you didn’t want me around, why didn’t you have the guts to tell me?” Well who told you… You know? I said, that’s been part of my evaluation, be honest with me. Said didn’t hear it from me, and I got that response from I think there were seven of them at that time.

Tacey A. Rosolowski, Ph.D:

I have to say, I mean it’s a story I’ve heard before in the institution. People not wanting to come face to face and say here’s the handwriting on the wall, and it ain’t nice. You know, people don’t want to have that conversation.J

Joyce Alt, RN, MS:

I even had a police check done on me, can you believe that?

Tacey A. Rosolowski, Ph.D:

Really?J

Joyce Alt, RN, MS:

And I was so close to the chief of police. I mean you do, when you’ve got that many people and females (inaudible), you’ve got to… Anyhow, he said, “Joyce, I’ve been asked to do this, I’ve done it, you’re fine,” and I said, “I can’t believe this.” They said it is [true].

Tacey A. Rosolowski, Ph.D:

You said you felt like what you were experiencing was not an isolated case, that there were other people.J

Joyce Alt, RN, MS:

Oh, yeah.

Tacey A. Rosolowski, Ph.D:

What was going on in the institution that was creating this scenario?J

Joyce Alt, RN, MS:

It’s like—and this is a terrible example, but I felt that finances were far more important than patient care, and I know finances are important, I’m not that stupid, but when it starts running how we manage patient care, I think it’s wrong. [These individuals came in as a team and left as a team.] [Redacted] [They left after not too long and I do not have any idea why.]

Tacey A. Rosolowski, Ph.D:

Now, are these individuals that were brought to MD Anderson to kind of make some of these financial changes to save the institution?J

Joyce Alt, RN, MS:

Yeah, I think so.

Tacey A. Rosolowski, Ph.D:

Okay, that was it. I mean it was a very stressful time.J

Joyce Alt, RN, MS:

It was.

Tacey A. Rosolowski, Ph.D:

Not an excuse for some of their decisions, but just to put it in context. Yeah. Because Dr. LeMaistre had seen the problems with the coming of HMOs, and all of these things.J

Joyce Alt, RN, MS:

Oh, yeah.

Tacey A. Rosolowski, Ph.D:

And had to take some pretty serious steps.[Redacted]

Tacey A. Rosolowski, Ph.D:

[Redacted] Who was running the show during that time?J

Joyce Alt, RN, MS:

[Redacted] [I am not sure. I wasn’t close enough to the top to know that. Leadership was changing at many different levels during this time.][Redacted]J

Joyce Alt, RN, MS:

[This was happening about one or one and a half years before I left.]

Tacey A. Rosolowski, Ph.D:

Okay, so like around ’93 or so.J

Joyce Alt, RN, MS:

I’m not real sure of that.

Tacey A. Rosolowski, Ph.D:

Yes. And so was that around the time when this group of consultants or kind of new administrators came in?J

Joyce Alt, RN, MS:

Yeah. And then I got a call one day, “Oh I forgot to tell you but you’re going to have a new boss.” [ ]

Tacey A. Rosolowski, Ph.D:

Who was your new boss?J

Joyce Alt, RN, MS:

Crosby.

Tacey A. Rosolowski, Ph.D:

Okay. First name?J

Joyce Alt, RN, MS:

I don’t know.

Tacey A. Rosolowski, Ph.D:

Is it Ken? I’m sorry, I’m like… I’ve heard the name.J

Joyce Alt, RN, MS:

[ ]

Tacey A. Rosolowski, Ph.D:

So it was a real turbulent time for the institution.JJoyce Alt, RN, MS:

It was. [Redacted]

Joyce Alt, RN, MS:

[Redacted] I wasn’t real sure who my boss was any more. She was directing me here and a physician was directing me there, and that’s just the way it was.

Tacey A. Rosolowski, Ph.D:

Which is telling in itself. I’ve heard other stories of people, you know they’re pretty highly placed, and then there’s an administrative shift and suddenly they don’t know, what does that upper leadership even look like any more.[Redacted]J

Joyce Alt, RN, MS:

Then, ethics became a real important part of Anderson really, and that, God, that committee fought for their very life [and to be accepted] family input into a decision, and I was very supportive of that.

Tacey A. Rosolowski, Ph.D:

I’ve been interviewing Mike Ewer [oral history interview]. Yeah.J

Joyce Alt, RN, MS:

Yeah. He’s our neighbor, right down the road.

Tacey A. Rosolowski, Ph.D:

Oh, is he really?J

Joyce Alt, RN, MS:

Yeah.

Tacey A. Rosolowski, Ph.D:

Oh, that’s cool.J

Joyce Alt, RN, MS:

And God, he got beat up so many times, but he’s a fellow that outwardly always says he could take it. He was melting inside too, you know?

Tacey A. Rosolowski, Ph.D:

So the Ethics Committee, so you had an early commitment to all of this, to sorting out these issues with patients. Now, did you work with the Ethics Committee at all?J

Joyce Alt, RN, MS:

No.

Tacey A. Rosolowski, Ph.D:

Okay.J

Joyce Alt, RN, MS:

And they really went down to another level and I think most of the people there were closer to the patients than I was, for whatever position they had. [ ] [Redacted]

Tacey A. Rosolowski, Ph.D:

Okay, yeah, so real pushback from physicians?J

Joyce Alt, RN, MS:

Yeah. Probably more from physicians than anybody, and it’s a proud hospital in that regard; [ ] Everybody had their own camp and we [should make ethical decisions.]

Tacey A. Rosolowski, Ph.D:

And big egos.J

Joyce Alt, RN, MS:

Yeah, and it was hard.

Tacey A. Rosolowski, Ph.D:

Now when Ethics was restructured or shut down, what did you think was going on with that? And I’m thinking, you know, you’re kind of watching this while you’re assessing your own situation, there’s obviously turbulence. Did you have any insight into what was affecting the decision around the Ethics Committee?J

Joyce Alt, RN, MS:

No, I really didn’t. [ ] I remember the night that [I quit]. I just left, I simply told Human Resources I was going home. Dr. Ewer came down and he brought me a bottle of champagne. (both laugh)

Tacey A. Rosolowski, Ph.D:

Well, hey.J

Joyce Alt, RN, MS:

He said, “You made it out,” and I said, “Well, I sure wish it wouldn’t have been this way.”

Tacey A. Rosolowski, Ph.D:

So you just retired and left the institution at that point?J

Joyce Alt, RN, MS:

Oh yeah. I knew it was coming. I had my office—I’d shut my door periodically and clean out, you know? I just knew it.

Tacey A. Rosolowski, Ph.D:

I’m sorry it happened that way.J

Joyce Alt, RN, MS:

I am too, I really am.

Tacey A. Rosolowski, Ph.D:

Yeah, seriously.J

Joyce Alt, RN, MS:

It has been hard, very hard to get over. I’m not over it. I mean yes, I’m over it, but it’s a hurt that probably will never go away.

Tacey A. Rosolowski, Ph.D:

No, I can well understand, and you’re not the first person who has talked about this.J

Joyce Alt, RN, MS:

I did feel I contributed, I tried. If nothing else, I tried with my whole soul, but…

Chapter 10: Leaving MD Anderson

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